Enlarged Prostate Treatment

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Treatment of benign enlargement of the prostate is medication, says Jayram Krishnan, DO, a urologist at Sunrise Hospital. In this video, he says that these medications were considered revolutionary for their ability to help patients urinate better.

The traditional surgical options for benign prostatic hyperplasia (BPH) may provide the best chance for improving urinary symptoms, but they also carry the greatest risk of complications. In the search for less risky procedures, less-invasive treatment options have been developed. These options are sometimes called device therapies because the doctor uses specific devices to apply heat to destroy tissue that may be obstructing the urethra or bladder outlet. The minimally invasive technologies available include:

transurethral vaporization of the prostate (TUVP or TVP)

transurethral microwave thermotherapy (TUMT)

transurethral needle ablation (TUNA)

visual laser ablation of the prostate (VLAP)

interstitial laser coagulation (ILC)

Be aware that some of these new technologies may not be available in your area or your local surgeons may not be experienced in using the new techniques. Also, insurance companies do not cover many of these procedures because the techniques are considered unproven and experimental.

Transurethral vaporization of the prostate (TUVP or TVP) is the most recently introduced technology to treat benign prostatic hyperplasia (BPH). TUVP was developed to overcome some of the major problems associated with the surgical procedure known as transurethral resection of the prostate (TURP), such as bleeding, catheterization time, and long hospital stays and recovery time.

The new technique is a modification of TURP: With TURP, a very thin, wire loop with an electric current is used to cut away pieces of the obstructing tissue in the prostate. In TUVP, a special, grooved, roller electrode (usually shaped like a cylinder) is inserted through a resectoscope, delivering a strong electric current. The roller electrode is rolled over the tissue, vaporizing -- instead of cutting away at -- the top 1 to 3 millimeters of tissue. (In this way, TUVP is comparable to laser vaporization techniques.)

Unfortunately, with each pass of the roller, the layer below the vaporized tissue becomes more solid, or coagulated. This coagulated tissue is harder to vaporize -- a drawback that makes the procedure more tedious and time-consuming. For this reason, TUVP is best limited to men with small prostates.

These minimally invasive procedures have some advantages over traditional surgery, but they must be viewed with caution. The long-term safety and durability of these procedures needs to be carefully evaluated before they are accepted as reasonable alternatives.

Randomized studies are needed to determine whether the new technology really does compare favorably to other tried-and-true treatment options, particularly transurethral resection of the prostate (TURP). A new technology may not closely approach TURP in terms of improving the peak urinary flow rate, but if the new procedure can provide a reasonable improvement with fewer risks, then it may be a legitimate option.

Studies on the long-term effectiveness of these technologies are also needed. Until these studies are reported, it is very difficult to say whether a newer technique is better or worse than drug therapy, surgery, or another minimally invasive procedure. If you are thinking about trying one of these surgical techniques, be sure to discuss the evidence regarding the various treatment options with your primary healthcare practitioner or urologist.

In the treatment of benign prostatic hyperplasia, or enlarged prostate, balloon dilation, also called balloon urethroplasty, is used to open up the urethra, the same way that a balloon angioplasty is used to open up the arteries in the heart. A thin tube containing a balloon is inserted into the opening of the penis and guided up the urethra to the point at which the urethra is narrowed. The balloon is then inflated, which widens the urethra and improves the flow of urine.

Balloon dilation is used only as a temporary procedure for men with multiple medical contraindications that put them at high surgical or anesthesia risk.

In laboratory studies, Pygeum africanum has been shown to inhibit prostate cell proliferation by reducing the response to a variety of growth factors. Pygeum africanum also is thought to produce anti-inflammatory effects and has been shown to improve bladder function in animal studies.

In Europe, a Pygeum africanum product called Tandenan is most commonly used. The usual dose is 100 mg per day.

There is limited research on the effectiveness of Pygeum africanum in men with symptomatic benign prostatic hyperplasia (BPH). As with most herbal therapies, most available studies on this bark are short term, and the supplements used are not standardized. In fact, when a review of the best quality studies using Tandenan (the European prescription product derived from Pygeum africanum) was attempted, no conclusions could be drawn because of inconsistency in the studies and results.

A few placebo-controlled studies from Europe, however, have demonstrated some positive effects.

In a six-week study involving 120 men, those who took Pygeum africanum had a greater improvement in several urinary symptoms than men who took a placebo.

Another study of 263 men over two months found that 66% of men taking Pygeum africanum felt that they improved, whereas 31% of men taking a placebo felt this way.

A number of products derived from pollen extracts have been proposed as treatments for benign prostatic hyperplasia (BPH). Most studies of these products involve a drug called Cernilton. Animal studies using Cernilton have shown that it can reduce the size of the prostate and inhibit hormone-stimulated growth.

A randomized, placebo-controlled trial of 60 men treated for BPH over six months showed that 69% of men who took Cernilton -- but only 29% of men who took a placebo -- felt that their condition had improved. There was improvement in some but not all symptoms -- nocturia and the sense of incomplete emptying were better with Cernilton -- but there was no difference in peak urinary flow rates between the two groups. Cernilton did lead to a decrease in prostate size.

Another four-month study compared Cernilton with Tandenan, which is a Pygeum Africanum product. The study involving 89 men showed that there was a greater improvement in symptoms, urinary flow rate, and post-void residual volume in men who took Cernilton than in men who took Tandenan.

The effectiveness of pollen extracts, such as rye pollen, to treat BPH remains to be proved. More studies of longer duration are needed to establish these extracts as a legitimate treatment for BPH.

In the treatment of benign prostatic hyperplasia (BPH), or enlarged prostate, high-intensity focused ultrasound (HIFU) uses ultrasound energy to heat and to destroy the obstructing prostate tissue instead of coagulating it as with transurethral microwave thermotherapy (TUMT) or transurethral needle ablation (TUNA). A transrectal probe gives off waves that focus on a precise area of the prostate. HIFU uses very high temperatures.

As an invasive procedure, HIFU should be effective and produce durable results. Early results of studies that focus on this technique are promising but not convincing. No placebo-controlled or randomized comparison studies have been reported. Such studies are needed before HIFU can be recommended as a viable alternative.